Thursday 26 April 2018

Itchy, scaling scalp and cold, burning fingers

Scalp psoriasis can lead to redness and irritation of the scalp
Scalp psoriasis can lead to redness and irritation of the scalp

Nina Byrnes

Advice from our GP on psoriasis of the scalp and cold, burning fingers.

Question: I have psoriasis on my scalp. It gets very itchy and red and is very frustrating. Have you any advice?

Dr Nina replies: Psoriasis is an inflammatory disease of the skin which leads to the build up of scaly white plaques. About half of those who has psoriasis will have some on their scalp.

Scalp psoriasis can lead to redness and irritation of the scalp. This may be very distressing to those affected. Intense scratching can lead to infection and hair loss. Hair then gets trapped in the scales, making it more different for it to slough off as it might in other places. The treatment of scalp psoriasis can also be more difficult as hair can act as a barrier, making it more difficult for creams and lotions to reach the affected skin.

Treatment can be messy and time-consuming and it can take up to eight weeks to get the scales under control. It is important to soften scales and try to remove them to maximise the benefit of other treatments.

A simple way to do this is to apply olive, arachis or almond oil to the scalp. Wrap hair in a warm towel and leave for about 30 minutes. Wash the hair, then while it is still damp take a fine comb and rotate in a circular motion across the scalp to loosen scales which can be gently brushed away. It is important to do this gently so as to avoid inflaming or traumatising the sensitive skin beneath.

Preparations that contain tar can be used in a similar way. Tar products can stain clothes and bedding and are messy to use. Products containing salicylic acid may also help loosen scale but may irritate the scalp.

Once scales are removed, steroid lotions or ointments can be applied. These reduce inflammation. Potent steroids are most effective. If steroids alone don't work, a vitamin D product may be prescribed.

Bacteria or yeast on the scalp may make scaling worse and using a medicated shampoo may also help maintain scalp clearance. These products should be massaged into the scalp. More severe cases of scalp psoriasis may require specialist referral. UV treatments can be helpful, especially in those with little or thin hair. In more severe cases oral medication may be prescribed.

Question: My hands often go white and then painful when cold. Have you any advice?

Dr Nina replies: Raynauds' phenomenon occurs when parts of the body change colour and become painful. This usually occurs in a particular pattern: the skin becomes white and cold, then becomes a dusky blue colour, before turning red, hot and often painful as colour returns.

The most common trigger for this is cold, but it can occur with any change in temperature or due to emotional stress. In nine out of 10 cases there is no underlying cause. In rare cases, this can be associated with more severe underlying autoimmune conditions.

In primary Raynaud's there is no underlying condition. In less than one in 10 cases, there may be an underlying condition such as scleroderma, lupus or rheumatoid arthritis. There may be other associated symptoms such as joint pain or swelling, or dry irritated eyes.

When you first attend your GP, it is likely they will run blood tests to rule out an associated autoimmune condition.

It is important to avoid smoking as this damages blood vessels. Caffeine may be a trigger for some so keep this to a minimum.

Keep warm.

Wear plenty of layers, put on gloves and hats while you are still warm and inside this will prevent the temperature change that can bring on symptoms.

Exercise regularly to help maintain healthy blood flow throughout the body.

If lifestyle measures alone don't work your doctor may advise prescription medicine.

Calcium channel blockers can help in Raynaud's.

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